Neonatal jaundice )3122/6/34 ( .

) (
Post term Preterm Term
bilirubin level

-2
-3
-4
-5
-6
-7
-8
-9

:
Sole abdomen & chest Level of jaundice
Petechia
HSM Liver & spleen
Suckling

-2
-3
-4
-5
Cephalohematoma - 5
Moro reflex - 7

:
)bilirubin total & direct( - 2

Physiological jaundice start from 3rd day 7th day

No risk factors, good general condition, good suckling
Bilirubin level up to 12 if term
Up to 14 if preterm

Pathological jaundice

1st 24 hour (before 3rd day )

Bilirubin level > 12 or 14 (term, preterm accordingly)
+ve risk factors (high risk pregnancy e.g. diabetic, P.E, Cardiac, twins, APH)
ABO incompatibility

AB B A O
RH incompatibility
+ve ( ) ve
Not affected

Threatened abortion, previous abortion

Bleeding with pregnancy

Previous transfusion with +ve blood

bilirubin total & direct
Direct bilirubin if > 20% = direct hyperbilirubinemia
Comb's test Autoimmune hemolytic anemia e.g. G6PDd

Septazole G6PDd
CBC, blood film, Retics
Retics is a marker for active bone marrow
Reticulocytosis if Retics > 2% = hyper active bone marrow
anemic or not Hb level

curve 3 curve bilirubin

phototherapy
blood exchange

curves 4
mild risk factors

moderate risk factors

severe risk factors
triple phototherapy double phototherapy phototherapy
genitalia
corneal & scrotal injury
Ryle Gastric rest
Fluids
extensive phototherapy

 56 triple

exchange transfusion curve
5 extensive phototherapy
phototherapy 1-2/Hour bilirubin
phototherapy already exchange transfusion

Indication Whole blood

RH O ABO
) O ( O +ve A +ve
O ve A ve
O ve RH Incompatibility
others e.g. G6PDd, anemia, sepsis
A +ve A +ve
double blood volume =
Blood volume = WT 80
transfusion 320 ml blood volume = 160 ml 9
Hyperkalemia Fresh
umbilical catheter
31 31 31 Pull & Push technique

4
1- Leader: Pull & push procedure
2- Monitor: hypoglycemia, electrolytes (esp. Ca +)
calcium Ca 211
3- Recoding: in/out
5 bilirubin & Albumin Post exchange
rebound hyperbilirubinemia

Breast **** jaundice

Breast milk jaundice

Breast feeding jaundice

( ) ( /
)glucose dehydration
bowl movements enterohepatic circulation jaundice